In 2009, the Americans Recovery and Relief Act (ARRA) targeted universal adoption of Electronic Health Records (EHRs) by 2014-15. This is based on the perceived ability of EHRs to improve communication, create truly portable medical records and improve overall patient safety, especially through reducing errors in medication ordering and administration. However, there is a growing awareness, as highlighted in the 2011 Institute of Medicine (IOM) report on EHR safety, that there are many unintended consequences to EHR use, which may in turn actually increase medical errors and in some instances increase patient mortality. This report gave overall EHR safety a grade of C+. The increase in errors with EHR use are attributed to issues related to data-findings, adverse effects on communication and cognitive errors, all of which are accentuated through problems with the EHR- user interface and sub-optimal training. These issues have been best described in the Intensive Care Unit (ICU), where point in time and longitudinal data density, patient acuity, alert fatigue and need fo urgent decision making bring these issues to the forefront. Consequently, we hypothesized that high- fidelity EHR simulation training would be able to identify the extent for potential EHR use errors, provide a means for improved EHR use and serve as a framework for an iterative process to improve global EHR training and redesign within our institution. Preliminary data with a simulated 5-day Medical ICU patient documented that daily users correctly identified only 40% of errors and patient safety issues within a case, defining the scope of the problem. In this proposal, we plan to 1. Expand our initial EHR simulation station to allow for robust usability analysis (through video eye-tracking and key logging) and create additional cases to expand both in the MICU and other ICU environments, 2. To determine whether repeated testing can improve EHR use and error recognition within the ICU, 3. To employ usability data to redesign EHR training and user interface and 4. To convene a consensus conference to establish the role for EHR simulation to improve use, education and design.